who is emotionally upset to the psychiatrist in time so that some of these problems can be eliminated before too much growth has transpired?

Dr. BARBA. This is one of the problems. The other problem is to find a psychiatrist equipped to handle these problems at this time, since most of the psychiatrists have been involved with the adult problems. It is comparatively few who are intimately related with the child problems.

There is another factor in this in that very few parents are willing to admit that their child needs this type of assistance, sir.

The CHAIRMAN. That has been pretty much true of many other fields, too.

Dr. BARBA. Yes.

The CHAIRMAN. That is, getting recognition on the part of the family.

Thank you very much.

Mr. NELSEN. No questions.

The CHAIRMAN. Dr. Steward H. Clifford, Boston Lying-in Hospital, Boston, Mass.?

Dr. COOKE. I think Dr. Clifford is unable to make it at this time, Mr. Roberts.

The CHAIRMAN. Dr. Clement A. Smith?

Dr. COOKE. Dr. Clement Smith, I think, notified the clerk that he was ill, and he had sent a statement and cannot be here.

The CHAIRMAN. Mr. Leonard W. Mayo, Chairman of the President's Panel on Mental Retardation?

Mr. Mayo, I believe we have had you before our subcommittee on many other occasions, and we are certainly happy to welcome you here today again.

STATEMENT OF LEONARD W. MAYO, CHAIRMAN OF THE PRESIDENT'S PANEL ON MENTAL RETARDATION, WASHINGTON, D.C.

Mr. MAYO. Thank you, Mr. Roberts, very much.

I think I should be heard today in a capacity other than the Chairman of the President's Panel on Mental Retardation, although I wish to make reference to that in my brief remarks. I am executive director, now on leave, of the Association for the Aid to Crippled Children in New York City, located in New York City, which has a national program in support of research in both this and other countries.

I am a member of the board of that organization, and, although I am on leave to give my full attention to the President's Panel on Mental Retardation, I can speak for the Association for the Aid to Crippled Children at this time

I do not want to claim necessarily that the association was "for Roosevelt before Chicago," but I will say, and I think the record will sustain it, that the association was and did become active in the field of congenital malformation and supportive research in this field more than 10 years ago, when the interest in this area of research was not as extensive, nor as fully developed by a long way, as it is today.

I think, therefore, from the point of view of this experience, it might be helpful to the committee if I stated the views of our organization, which I am sure are reflected by others who are, let us say, in the field

of private foundations. It has been our goal and objective in the last several years to work very closly with the National Institutes of Health. We have been able to start a number of projects which later proved their worth, so that the NIH, upon application, felt that they could go on for long-term support of them, and we have in other ways worked very closely, both in policy matters as citizens and in supplementary activities, in supportive research and demonstrations.

We have long been of the opinion that it would be extremely valuable to move now into extensive research in normal growth and development, so-called, in addition to the continuation, of course, of research in specific diseases and aberrations. I think that the layman might well ask and, in fact, I think at the beginning of this proposal some of my board members asked whether this would not constitute duplication, this new Institute might not constitute some duplication, within the National Institutes of Health.

It seems to me, as laymen, we have to be as sensitive to the leads that new knowledge gives us with respect to structure and administration as the scientist must be sensitive to leads he gets in the laboratory with respect to new leads in research. And I think the new knowledge that has been revealed in the last several years indicates clearly that emphasis upon normal growth and development, the learning process, studies of the intellect, the total aging process from conception on through to the end of the lifespan, can contribute something to our knowledge of man, without which we cannot effectively continue our research for the answer to diseases and aberrations. And so the association which I represent is solidly behind both proposals (that is, for both of the Institutes). I am very much impressed with the fact that these proposals did not come to the attention of the Congress until they had been quite thoroughly tested by many conferences throughout the country and in the case of the Division of General Medical Sciences, tested administratively for some time before the proposal came to the fore with respect to a separate Institute. I think that the layman also is very apt to ask the question as to how other Institutes would regard this new development, and I would say that I could not be for the new Institute if I were not assured personally by the heads of the other Institutes that the establishment of the new one would in no way diminish their continuing efforts in terms of the research that has to do with children.

For example, Dr. Masland would not be one whit less interested in the children's problems within the Institute of Neurology, nor will the Cancer Institute be one whit less interested in problems of cancer in children, and the like.

I think that the sum total will be an increased activity, rather than the opposite, and a focus on growth and development which we do not presently enjoy and which I feel the field of research very much needs.

I would like to support the testimony brought out in the administration testimony this morning, which I listened to with great interest, and the points that Dr. Cooke has made.

I believe it is extremely important that appropriate relationships be worked out with the Children's Bureau, because I believe that the Bureau has made a very substantial contribution to this whole field and should continue to do so, and I think that the divisions of

81475-62- -6

labor suggested by the administration and supported by Dr. Cooke in this connection are thoroughly sound.

I would like to speak just very briefly with respect to the interest of those of us now working in the field of mental retardation as it relates to this proposed Institute. It is very important that we have research on learning, on the intellect, on the growth process, in order that we may profit by the results of such research in studying the prevention of mental retardation and in doing the best we can to make those who are mentally retarded as productive as possible in society.

Study of the learning process, which perhaps has gone further in some countries than this, is one aspect of the problem in which those of us now in the field of mental retardation are very deeply interested. I would like to say one more word, if I might, with regard to the international implications of the new Institute, particularly the one on Child Health and Development.

First I want to say that I am very glad that Dr. Cooke included in his testimony the inclusion of the field of obstetrics and the important matter of relation between mother and child, the maternal aspects, which I would also like to heartily endorse.

I am not sure that all Members of the Congress involved in the matters we are discussing here today are as aware as I am of the tremendous impact, quite over and beyond the grants we make abroad, that the National Institutes of Health is having on the entire world in emphasizing the importance of human life.

On a recent trip 2 weeks ago to Holland, England, and Switzerland, and a visit to the WHO Board meeting with people from many other countries, great interest was expressed in these proposals for two new Institutes. Interest is always expressed in the leadership the Children's Bureau gives, and I think we cannot underestimate the kind of encouragement our Government provides, particularly behind the Iron Curtain, on things other than defense needs and the exploration of outer space.

Our emphasis on the dignity of human life is one of the great contributions this country can make, and I think the proposals before us in this bill will make it possible for us to continue that contribution both on a scientific and humane level throughout the world.

The CHAIRMAN. Thank you very much, sir. We appreciate your

statement.

Our next witness will be Dr. Richard T. Smith, professor and chairman of the Department of Pediatrics, University of Florida, Gainesville, Fla., who will be presented by his Congressman, Mr. Matthews.

STATEMENT OF HON. D. R. MATTHEWS, A REPRESENTATIVE IN CONGRESS FROM THE EIGHTH CONGRESSIONAL DISTRICT OF THE STATE OF FLORIDA

Mr. MATHEWs. Thank you so much, Mr. Chairman.

I want to thank the committee for having these hearings, and I want to congratulate the witnesses who have appeared here today and who have have made such excellent statements.

As most all of us in Congress, I, too, am an enthusiastic supporter of our National Institutes of Health, and I certainly want to associate myself with the wonderful statements that have been made.

In particular I want to have the pleasure of introducing Dr. Smith, who, as the chairman has indicated, is from my home city, my friend and constituent, and, with whose views, I would like now to associate myself.

Thank you very much, Mr. Chairman, for permitting me to present Dr. Smith.

The CHAIRMAN. Thank you, Mr. Matthews. We are always happy to have you. Mr. Matthews is my long-time next-door neighbor here on the third floor, and I do not know of a more devoted, able, and dedicated Member of our body than Congressman Matthews. Dr. Smith, nice to have you.

STATEMENT OF RICHARD T. SMITH, M.D., PROFESSOR AND CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS, UNIVERSITY OF FLORIDA, GAINESVILLE, FLA.

DR. SMITH. Mr. Chairman, Mr. Nelsen, Congressman Matthews, I am honored to appear today in support of H.R. 8398, legislation proposing, among other things, a National Institute of Child Health and Human Development. I speak for myself, as head of the pediatric department of one of the newer southern medical schools, and as an individual concerned daily with basic research, education, and practical clinical applications in the developmental problems and diseases of children. I also appear on behalf of the Society for Pediatric Research, a national association of over 200 young research workers in fields related to child health.

As this committee knows well, the National Institutes of Health have done a remarkable job over the past 12 years in stimulating medical research and medical education in this country and throughout the world. As problems have been identified, research efforts have been wisely and systematically marshaled with results that have contributed already significant breakthroughs in infectious disease, nutrition, heart disease, and mental health. This categorical approach to health problems has yielded abundantly in new basic knowledge, practical applications, and a body of highly skilled and productive research personnel scattered around the Nation and around the world.

It is now recognized by the proposed legislation that the health problems associated with human growth and development cross such categorical lines at many levels, and are confined to none of them. Prematurity and its associated birth defects is one example with which I am personally familiar, of such a broadly based problem. This one is extremely important in our region of the country where 1 out of 6 or 7 babies born is premature, as contrasted to the national average of about 1 in 14. The causes of prematurity that we see may reach back to the earliest stages of pregnancy and faults in development, be related to some disease of the mother, or be due to an inherited trait. The high incidence of birth defects can involve the heart, the brain, the eyes, or any other organ. Serious infections which take a high toll of such infants are peculiar to this age group. A distressing proportion of infants we nurse successfully through the touch-and-go of premature birth end up intellectually, if not physically, crippled. The rewards of success in this problem like all others in child health are great, however. Whereas cancer treatments and some treatments

for heart disease are measured in terms of 5-year survivals, every successful effort in preventing early death or crippling in the young infant has a 67-year survival value.

A massive effort toward solving some of these problems can be made possible through the mechanism of the proposed Institute. Through the Institute the several basic sciences dealing with development can receive added emphasis developmental biology, chemical embryology, genetics, teratology, developmental psychology, phylogenetic studies of the reproductive process. More rapid evolution from laboratory to clinical application in child health and to the reproductive processes by obstetrics, psychology, psychiatry, pediatrics, and other medical disciplines, will be insured. Clinical research in these latter fields will be greatly strengthened.

The first and most serious continuing problem each of the existing Institutes has had to meet in the beginning is the shortage of trained research personnel, qualified to carry out the aims of its programs. In some areas clinical training had to precede research training in order to attract sufficient numbers of qualified people into the academic field, as was true in the case of the Neurological Institute. In other Institutes, existing clinical programs supplied adequate numbers of people who were prepared for research training.

In the broad fields of child health and human development a serious shortage of research personnel exists in all areas, and would represent, in my opinion, the first major challenge of the proposed Institute. At all levels from student and predoctoral through postdoctoral and senior staff, research training would have to be initiated or reinforced heavily where it already exists.

A first order of business, therefore, would be major strengthening of training in the basic sciences relating to human development. In all clinical research training programs strong emphasis should be given to a basic research orientation by the clinician who will deal with the problems of birth defects and human development. To the few outstanding programs which exist, talented individuals should be attracted so that they can establish further centers for studies in the developmental sciences. In my opinion any new centers for research and training in developmental sciences should not be established in isolation, but in such institutions where interdisciplinary coordination and cooperation can assure the most rapid evaluation and application of new concepts and principles to pressing problems of child health.

In the clinical fields, the natural alliance of interests of the obstetrician and pediatrician in the pre- and post-natal development of children could and should be actively encouraged and exploited in joint research training programs. It is through such cooperative endeavor that the eventual goal of prevention of inherited and acquired birth defects will come about. One can visualize a time when knowledge of carrier states for inherited traits in the infant, and of environmental influences on pregnancy, are sufficiently well understood so that practical preventive or corrective measures might be taken before they produce irreversible birth defects.

Accordingly, I would endorse strongly the clear statement of the mandate of the Institute of Child Health and Human Development to include references to maternal health, suggested by Dr. Robert Cooke in his presentation before this committee.

At the clinical level, a distressing shortage exists of physicians qualified by neurological, biochemical and psychological or psychiat